NHS England guidance sets out expectations for ICS governance and management arrangements

A recent NHS England and NHS Improvement (NHSEI) document has provided an overview of how it expects integrated care systems (ICSs) will be governed and managed from April 2022.

ICSs are a new way of working across NHS and councils, which operate by cooperating with one another to manage pressures, pooling resources and budgets, improving patient outcomes, removing silos and enhancing productivity.

Entitled ‘Integrated Care Systems: design framework’ NHSEI’s latest guidance is based on the objectives articulated in the UK Government’s important whitepaper on integrating health and social care.

Content referring to new statutory arrangements and duties, and/or which is dependent on the implementation of such arrangements and duties, is subject to legislation and its parliamentary process. Therefore, the document recommends that systems do not act as though the legislation is in place or inevitable but rather make reasonable preparatory steps.

Alongside discussing two key aspects of ICSs from next year – ICS Partnerships and ICS NHS bodies – that will be instrumental in ensuring ICSs’ success and ensuring health and social care services are joined up, the guide also outlines NHS England’s expectations for ICS governance and management arrangements.

It reads: “Strong and effective governance and management arrangements are essential to enable ICSs to deliver their functions effectively. The pandemic has shown the success of partnership approaches that allow joined-up, agile and timely decision-making underpinned by common objectives.

“ICSs will build from this to establish robust governance and management arrangements that are flexibly designed to fit local circumstances and that bind partners together in collective endeavour.”

Below, AT Today has detailed some of the key points mentioned in the document about these expectations.

The ICS NHS board

ICS NHS bodies, as a new type of organisation, will have different governance arrangements to those of existing commissioner and provider organisations in the NHS.

These bodies will bind partner organisations together in a new way with common purpose, lead integration within the NHS, and establish shared strategic priorities within the NHS.

NHS England expects that each ICS NHS body will have a unitary board. This board should be constituted in a way so that it focuses on improving outcomes in population health and healthcare; tackling inequalities in outcomes, experience and access; enhancing productivity and value for money; and contributing to broader social and economic development.

All members of the ICS NHS board will have shared corporate accountability for delivery of the functions and duties of the ICS and the performance of the organisation. This includes ensuring that the interests of the public and people who use health and care services remain central to what the organisation does. The board will be the senior decision-making structure for the ICS NHS body.

Although the statutory minimum membership of each board is to be confirmed in legislation, NHSEI expects each ICS NHS board to include the following rules for effective operation:

Independent non-executives

Chair plus a minimum of two other independent non-executive directors. These individuals will normally not hold positions or offices in other health and care organisations within the ICS footprint, the document suggests.

Executive roles (employed by the body)

Chief executive (who will be the accountable officer for the funding allocated to the ICS NHS body), director of finance, director of nursing and medical director.

Partner members

A minimum of three additional board members, including at least:

• one member drawn from NHS trusts and foundation trusts who provide services within the ICS’ area
• one member drawn from the primary medical services (general practice) providers within the area of the ICS NHS body
• one member drawn from the local authority, or authorities, with statutory social care responsibility whose area falls wholly or partly within the area of the ICS NHS body

The document adds: “ICS NHS bodies will be able to supplement these minimum board positions as they develop their own ICS NHS body constitution, which will be subject to agreement with NHS England and NHS Improvement.”

In addition, each ICS NHS board should include all parts of the local health and care system across physical and mental health, primary care, community and acute services, patient and carer representatives, social care and public health, with directors of public health having an official role in the ICS NHS bodies and the Partnership.

Committees and decision-making

All ICS NHS bodies will need to put arrangements in place to ensure they can effectively discharge their full range of duties and functions. The document says this is likely to include arrangements for committees and groups to advise and feed into the board, and to exercise functions delegated by the board.

Boards may be supported by an executive group including, for example, other professional and functional leads, to manage the day-to-day running of the organisation.

These arrangements should address the cross-cutting functional responsibilities of the body including finance and resources, people, quality, digital and data performance and oversight. They should enable full involvement of clinical and professional leaders, leaders of place-based partnerships and providers, including relevant provider collaboratives.

NHS England expects that the ICS NHS body will have arrangements that bring all relevant partners together to participate in decision-making.

Additionally, NHSEI believes that each board will be required to establish an audit committee and a remuneration committee. The board may establish other decision-making committees, in accordance with its scheme of delegation. The board may also establish advisory committees to advise it on discharging certain duties, such as public and patient engagement.

Upcoming legislation is expected to give ICS NHS bodies flexibility in how they establish and deploy such committees.

Place-based partnerships

NHSEI further predicts that place-based partnerships will be consistently recognised as key to the coordination and improvement of service planning and delivery, and as a forum to allow partners to collectively address wider determinants of health. These partnerships between organisations collectively plan, deliver and monitor services within a locally defined ‘place’.

The arrangements for joint working at place should enable joined-up decision-making and delivery across the range of services meeting immediate care and support needs in those local places but should be designed flexibly to reflect what works in that area, the guidance notes.

The document continues: “At a minimum, these partnerships should involve primary care provider leadership, local authorities, including directors of public health, providers of acute, community and mental health services and representatives of people who access care and support.”

Importantly, the ICS NHS body will remain accountable for NHS resources deployed at place level.

Supra-ICS arrangements

There are some functions where ICS NHS bodies will need to work together, NHSEI outlines, for example, commissioning more specialised services, emergency ambulance services and other services where relatively small numbers of providers serve large populations, and when working with providers that span multiple ICSs or operate through clinical networks.

The governance arrangements to support this will need to be co-designed between the relevant providers, NHS ICS bodies clinical networks or alliances and, where relevant, NHS England and NHS Improvement regional teams.

Quality governance

The document says that ICS NHS bodies will have statutory duties to act with a view to securing continuous improvement in quality. NHSEI expects each body to have arrangements for ensuring the fundamental standards of quality are delivered, such as addressing inequalities in service provision, and to promote continual improvement in the quality of services.